Q&A: Endogenous Depression, Psychiatric Meds, and Chinese Herbs

There is more than one type of depression. Many people have heard of bipolar, or 'manic' depression. And there are various names for major depression such as clinical depression. There are alternatives to treating depression with the typical medications (drugs such as effexor, prozac, and depakote). In this Q&A I discuss natural herbal alternatives in the light of both psychiatry and oriental medicine.

* This article is for informational/education purposes only and is not meant to substitute for the in-person professional advice of one's biomedical or chinese medical physician. On the contrary, it is advised that one consult with their health care professionals before making any changes in well-being strategies.

Hello Brian,

Would it be possible to give me a little information on an herbal medicine I bought called Xiao Yao Wan? I spoke to a young lady who specializes in chinese medicine and told her that I had suffered from endogenous depression for 1 year that was 5 years ago but since then I have been on antidepressants... first seroxat and now effexor. I desperately want to come off of these pills because of side effects but could not bear the thought of the depression comming back. I would be grateful if you could tell me if this is a genuine herbal remedy. I would give anything to be rid of this awful debilitating disease.

I welcome your reply,
Sue

Sue,

A lot of people want to make the shift from psychiatric medications to 'natural' solutions and then ultimately to a well-being that doesn't require constant medication of any kind. This is an area of particular interest to me. And it is a complicated issue. Discontinuing psychiatric medications is a major change, and would be most safely and successfully accomplished under the care of both a psychiatrist and a well-trained chinese medical practitioner. Later on I will tell you how to find one. This is not a well-explored area of medicine, so it is fraught with risks.

We can't ignore the potential dangers; any change in your medication falls under the responsibility and expertise of your psychiatrist. It's good to have a psychiatrist who is open to alternative medicine. It's not good to go off half-cocked and make medication changes without the advice of qualified health professionals. There are a lot of armchair herbalists out there, and many patients are taking their health into their own hands by prescribing themselves supplements and other alternative interventions. They say the doctor who treats himself has a fool for a patient, and how much more patients who treat themselves? This can range from harmless to life-threatening, and the reason for modern civilization's laws which mandate formally trained and licensed health professionals. Also, in modern healthcare, because there are widely distinct philosophies and beliefs at work among the different medicines, because not all health pracitioners communicate with one another, because the power has moved into the hands of patients, and because patients often do not feel comfortable telling their M.D.'s the truth, there is a lot of unmonitored amateur experimentation going on. As I have said, this can be dangerous.

It is important to remember how debilitating and dangerous one's depression was before they went on the meds, especially if they were suicidal. Any change in meds could precipitate a return to that life-threatening condition. Substituting the most appropriate herbal medicines while reducing the dosage of antidepressants might work over a period of 6 months to a year, but during that time there should be close monitoring by psychiatrist and chinese medical practitioner.

As in all medicines, before there is treatment of any kind (herbs, drugs, surgery, acupuncture), there must be a diagnosis. Diagnosis means complete knowledge. For a chinese medical practitioner to get complete knowledge of your situation (complete enough to prescribe an herbal formula) they must question and examine you. It is not sufficient to know the western or psychiatric diagnosis. A chinese medical practitioner needs to know more than 'endogenous depression' in order to prescribe the correct herbal formula. I'm including a flowchart to show you a bit of the complexity involved in getting the right formula. You'll see a modification of Xiao Yao called Dan Zhi Xiao Yao San on the chart.

		A psychiatrist would make a more specific diagnosis according to the DSMIV (APA Manual of Diagnosis and Statistics, Volume 4) such as Major Depression,
Bipolar type I or II, Dysthymia, etc. Ideally, after an MD has ruled out organic causes such as hypothyroidism, adrenal problems, nutritional deficiency, chronic infection, a chinese practitioner can conduct his own examination and evaluation to come up with the most appropriate herbs. Another aspect of chinese herbal medicine is that the formula you need will change to a degree with improvements in health. The good news is that herbal formulas in raw, tincture, or powder form can be personalized to eliminate all side effects, even the side effects of pharmaceuticals. There is more and more good info about drug-herb interactions out there in case your psychiatrist is concerned.

		Xiao Yao Wan is indeed a 'genuine herbal remedy.' It is a classic chinese herbal formula from the 10th century A.D. that deals with Liver/Spleen imbalances.
It is a commonly prescribed formula in modernized societies because it addresses one type of imbalance that results from our high stress levels, poor eating habits, mental overwork and overwhelm, and physical inactivity. But, none of this is sufficient to prescribe Xiao Yao Wan. Again, I want to direct you to a local practitioner to diagnose and treat with in conjunction with your psychiatrist.

Please read my '7 Steps to Preventing Disease with Chinese Medicine' for a discussion of how to find and work with a good chinese medical practitioner. It has not escape me that you are writing from the U.K. You will find plenty of U.K. practitioners from which to choose via the 'find a practitioner' link in the above-mentioned article.

		I know effexor causes some nasty side effects and withdrawal symptoms (common side effects are asthenia, sweating, nausea, constipation, anorexia, vomiting, somnolence, dry mouth, dizziness nervousness, anxiety, tremor, blurred vision, and abnormal ejaculation/orgasm
and impotence in men, and withdrawal can lead to nausea, headache, gastric upset, diarrhea, myalgia, and fatigue; withdrawal can be helped by a tapered dosage of ondansetron, a medication more commonly used for the treatment of nausea and vomiting during radiotherapy and chemotherapy.) Herbal formulas can also alleviate those side effects and withdrawal symptoms.

You will have to weigh your current discomfort with side effects against the risks of discontinuing your pharmaceuticals. A middle road might be for your chinese medical practitioner to start treating you for a period of time to improve your health and well-being until you hit a plateau, at which point you would be in a better position to make the transition off of the psych meds. Or, you might find that professional herbal treatment can satisfactorily eliminate the pharmaceutical side effects. Again, this is a complex and sensitive issue, and I hope you submit to the care of professionals. If you decide to embark on this cooperative effort with a psychiatrist and chinese medical practitioner, I would love to hear your about progress and, regardless, please feel free to ask me for clarification or any more questions you might have.

Yours in health,
Brian B. Carter

"'Sad Woman" image by Getty Images